title: Chronic kidney disease and diabetes in the national health service: a cross-sectional survey of the U.K. national diabetes audit.
abstract: OBJECTIVE
  We investigated the prevalence of chronic kidney disease and attainment of therapeutic targets for HbA1c and blood pressure in a large U.K.-based diabetes population.
  
  
  METHODS
  The U.K. National Diabetes Audit provided data from 1 January 2007 to 31 March 2008. Inclusion criteria were a documented urinary albumin:creatinine ratio and serum creatinine. Patients were stratified according to chronic kidney disease stage and albuminuria status. Chronic kidney disease was defined as an estimated glomerular filtration rate < 60 ml min(-1) 1.73 m(-2) , albuminuria or both. The proportions of patients achieving nationally defined glycaemic and systolic blood pressure targets were determined.
  
  
  RESULTS
  The cohort comprised 1,423,669 patients, of whom 868,616 (61%) met inclusion criteria. Of the patients analysed, 92.2% had Type 2 diabetes. A higher proportion of people with Type 2 diabetes (42.3%) had renal dysfunction compared with those with Type 1 diabetes (32.4%). Achievement of systolic blood pressure and HbA1c targets was poor. Among people with Type 1 diabetes, 67.8% failed to achieve an HbA1c < 58 mmol/mol (7.5%). Of all people with diabetes, 37.8% failed to achieve a systolic blood pressure < 140 mmHg. Blood pressure control was poor in advanced chronic kidney disease. For example, mean (standard deviation) systolic blood pressure rose from 128.6 (15.4) mmHg among people with Type 1 diabetes and normal renal function to 141.0 (23.6) mmHg in those with chronic kidney disease stage 5 and macroalbuminuria.
  
  
  CONCLUSIONS
  The high prevalence of chronic kidney disease and poor attainment of treatment targets highlights a large subset of the diabetes population at increased risk of cardiovascular mortality or progressive kidney disease.
authors.affiliation: Centre for Public Health, Queen's University Belfast, Belfast, UK; Regional Nephrology Unit, Belfast City Hospital, Belfast, UK.
authors.forename: C J
authors.initials: CJ
authors.lastname: Hill
authors.forename: C R
authors.initials: CR
authors.lastname: Cardwell
authors.forename: C C
authors.initials: CC
authors.lastname: Patterson
authors.forename: A P
authors.initials: AP
authors.lastname: Maxwell
authors.forename: G M
authors.initials: GM
authors.lastname: Magee
authors.forename: R J
authors.initials: RJ
authors.lastname: Young
authors.forename: B
authors.initials: B
authors.lastname: Matthews
authors.forename: D J
authors.initials: DJ
authors.lastname: O'Donoghue
authors.forename: D G
authors.initials: DG
authors.lastname: Fogarty
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000453:epidemiology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000652:urine; D005260:Female; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000652:urine; D012307:Risk Factors; D012720:Severity of Illness Index; D013222:State Medicine; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human